Predicting mammography utilization through model generation

Associations Between Cancer Fatalism, Causal Attributions, and Perceptions of Benefits and Barriers to Screening for Colorectal Cancer

BACKGROUND

The aim of the study was to assess the associations between cancer causal attributions (divine providence, chance or luck, environmental or genetic factors, weak personal resilience), cancer fatalistic beliefs (cancer occurrence and outcome beliefs), and benefits of and barriers to screening for early detection of colorectal cancer.

METHODS

It was a cross-sectional study of 252 individuals (46% men and 54% women) aged 50-75. Participants completed measures of cancer causal attributions, Powe's cancer fatalism questionnaire, and the benefits and barriers to colorectal cancer screening subscales of the health belief model. The study model was assessed using path analysis and mediation tests.

RESULTS

Participants expressed moderate levels of occurrence and outcome of fatalistic beliefs, moderate levels of causal attributions, a high level of perception of the benefits of screening, and a moderate level of barriers to screening. The path model showed good fit measures (χ² = 17.38, df = 14, p = .24; χ²/df = 1.24; NFI = .98; TLI = .99; CFI = .99; RMSEA = .03, 90% CI = .01, .07). Outcome fatalism mediated the relationship between each causal attribution and perceived barriers, whereas occurrence fatalism mediated only the relationship between the causal attribution of divine providence and the perceived benefits of screening.

CONCLUSIONS

The results add to our understanding of the effects of causal attributions and fatalistic beliefs on perceptions of benefits and barriers to screening; hence, these factors should be the focus of change to reduce barriers to screening for early detection of cancer.

Cognitive and affective correlates of decisional balance regarding screening mammography in older women

Participation in screening mammography remains suboptimal. This research aimed to improve understanding of ways to facilitate screening mammography attendance. One hundred and forty-two women from Gold Coast, Australia, aged 50-75, participated in the study. Social cognitive variables were assessed as potential predictors of mammography attendance. Most participants (79%) were maintaining regular screening mammography. Greater knowledge of breast cancer was the strongest predictor of decisional balance in favor of attending screening. Women who had relapsed from screening had significantly lower breast cancer worry than those contemplating attending for the first time. The results were consistent with previous research and point to factors screening services could consider to increase uptake.

Pancreatic cancer surveillance among high-risk populations: knowledge and intent

Pancreatic cancer is the fourth most common cancer in both men and women in the United States. It has the lowest survival rate of all cancers, largely due to the presence of non-specific symptoms, leading to diagnosis at advanced stages. While the majority of cases of pancreatic cancer are sporadic, up to 10% may be associated with an inherited predisposition. Currently, there is no standard screening protocol for pancreatic cancer, although this will change in the future as technology improves. Additionally, there is little information regarding the perceptions and intent to screen for pancreatic cancer among those with an increased risk due to a hereditary cancer predisposition syndrome, which was the objective of this study. Focus groups and individual telephone interviews were conducted, with questions focused on knowledge about pancreatic cancer and screening, perceived motivators, and perceived barriers related to each of the screening techniques currently available. Participants were recruited from the High Risk Breast Cancer and Pancreatic Cancer Registries at Huntsman Cancer Institute. The findings of this study indicated that individuals from these high-risk groups have low knowledge levels of pancreatic cancer screening, despite their desire for this information. Motivation to undergo a particular screening technique is related to whether the test is recommended by a physician, cost, degree of invasiveness, and comfort level. This information is useful to genetics professionals who counsel at-risk individuals, physicians who formulate patient care plans, and translational researchers who are developing pancreatic screening methods.

Concerns about dose and underutilization of twelve-step programs: models, scales, and theory that inform treatment planning

Researchers have observed that a majority of addicted persons who are encouraged and facilitated by treatment providers to attend twelve-step (TS) programs either drop out or sporadically use twelve-step programs following treatment. This is troubling given considerable evidence of TS program benefits associated with regular weekly attendance and ubiquitous reliance by treatment professionals on these programs to provide important support services. This chapter reviews and advances theory of TS utilization and dose that is supported by prior research, multivariate models, and scales that predict risk of TS meeting underutilization. Advancing theory should organize and clarify the process of initial utilization, guide intervention development, and improve adherence of TS program referrals, all of which should lead to improved treatment planning and better outcomes. Three theories are integrated to explain processes that may influence TS program dose: the health belief model, self-determination theory (motivational theory), and a person-in-organization cultural fit theory. Four multidimensional scales developed specifically to predict participation are described. Implications for practice and future research are considered in a final discussion. Information contained in this chapter raises awareness of the need for TS-focused treatments to focus on achieving weekly attendance during and after treatment.

Predictors of mammography screening among ethnically diverse low-income women

BACKGROUND AND PURPOSE

Breast cancer is the second leading cause of cancer deaths among women in the United States. Minority women are less likely to be screened and more likely to die from breast cancer than are Caucasian women. Although some studies have examined ethnic disparities in mammography screening, no study has examined whether there are ethnic disparities among low-income, ethnically diverse women. The present study was designed to determine whether there are ethnic disparities in mammography screening and predictors of screening among low-income African American, Mexican American, and Caucasian women, and to determine whether the disparities and predictors vary across ethnic groups.

METHODS

The participants were 146 low-income women who were Mexican American (32%), African American (31%), or Caucasian (37%). Statistical analyses were performed to assess the relationships between mammography screening during the past 2 years and potential predictors of screening, both within ethnic groups and for the combined sample.

RESULTS

The results varied depending on whether analyses combined ethnic groups or were performed within each of the three ethnic groups.

CONCLUSIONS

It is, therefore, important to examine within-group differences when examining ethnic disparities in predictors of mammography.

Health beliefs and pediatric emergency department after-care adherence

This study's purpose was to apply a multivariate adaptation of the Health Belief Model (HBM) to examine parental adherence to pediatric emergency department (ED) after-care instructions. Parents/legal guardians (n = 162) of children ages 0-17 years with minor (noncritical) conditions (e.g. abrasion/contusion, laceration) completed health beliefs and demographics questionnaires while waiting for their child to be seen. Postdischarge, children's medical records were reviewed for after-care instructions and insurance status, and parents were phoned to assess adherence to specific after-care instructions. In logistic regressions, health beliefs (barriers, severity, susceptibility) and child age significantly predicted several postdischarge adherence behaviors, including home care procedures and prescription medication purchase. Results are discussed as they relate to the effects of specific health belief variables and the need for further refinement of the HBM in accordance with the changing health care system; clinical applications are proposed.